Monthly Archives: December 2012

multiple system atrophy

Multiple System Atrophy view related topics in this manual Multiple system atrophy is a relentlessly progressive neurodegenerative disorder causing pyramidal, cerebellar, and autonomic dysfunction. It includes 3 disorders previously thought to be distinct: olivopontocerebellar atrophy, striatonigral degeneration, and Shy-Drager syndrome. Symptoms include hypotension, urinary retention, constipation, ataxia, rigidity, and postural instability. Diagnosis is clinical. Treatment […]

horner’s syndrome

Horner’s Syndrome Horner’s syndrome is ptosis, miosis, and anhidrosis due to dysfunction of cervical sympathetic output. Etiology Horner’s syndrome results when the cervical sympathetic pathway running from the hypothalamus to the eye is disrupted. The causative lesion may be primary (including congenital) or secondary to another disorder. Lesions are usually divided into Central (eg, brain […]

Autonomic Neuropathies

Autonomic Neuropathies Share This view related topics in this manual Autonomic neuropathies are peripheral nerve disorders with disproportionate involvement of autonomic fibers. The best known autonomic neuropathies are those accompanying peripheral neuropathy due to diabetes, amyloidosis, or autoimmune disorders. Autoimmune autonomic neuropathy is an idiopathic disorder that often develops after a viral infection; onset may […]

ans

Overview of the Autonomic Nervous System Share This The autonomic nervous system (ANS) regulates physiologic processes. Regulation occurs without conscious control, ie, autonomously. The 2 major divisions are the sympathetic and parasympathetic systems. Disorders of the ANS cause autonomic insufficiency or failure and can affect any system of the body. Anatomy The ANS receives input […]

pain

Overview of Pain Share This Pain is the most common reason patients seek medical care. Pain has sensory and emotional components and is often classified as acute or chronic. Acute pain is frequently associated with anxiety and hyperactivity of the sympathetic nervous system (eg, tachycardia, increased respiratory rate and BP, diaphoresis, dilated pupils). Chronic pain […]

fatal insomnia

Fatal insomnia is a typically hereditary prion disorder causing difficulty sleeping, motor dysfunction, and death. FI, a very rare disease, usually results from an autosomal dominant mutation, but several sporadic cases have been identified. Average age at onset is 40 yr (ranging from the late 30s to the early 60s). Common early symptoms include difficulty […]

creutzfeldt jacob disease

Creutzfeldt-Jakob Disease (CJD) Share This Creutzfeldt-Jakob disease is a sporadic or familial prion disease. Bovine spongiform encephalopathy (mad cow disease) is a variant form. Symptoms include dementia, myoclonus, and other CNS deficits; death occurs in 1 to 2 yr. Transmission can be prevented by taking precautions when handling infected tissues and using bleach to clean […]

prions disease

Overview of Prion Diseases (Transmissible Spongiform Encephalopathies) Share This Prion diseases are progressive, fatal, and untreatable degenerative brain disorders. They include Creutzfeldt-Jakob disease (CJD), the prototypic example Gerstmann-Sträussler-Scheinker disease (GSS) Fatal insomnia (FI) Variant CJD (vCJD) Kuru Prion diseases usually occur sporadically, with a worldwide annual incidence of about 1/1 million. Prion diseases result from […]

psp

Progressive supranuclear palsy is a rare, degenerative CNS disorder causing loss of voluntary eye movements, bradykinesia, muscular rigidity with progressive axial dystonia, pseudobulbar palsy, and dementia. The cause of progressive supranuclear palsy is unknown. Neurons in the basal ganglia and brain stem degenerate; neurofibrillary tangles containing an abnormally phosphorylated tau protein are also present. Multiple […]

apraxia

Apraxia is inability to execute purposeful, previously learned motor tasks, despite physical ability and willingness, as a result of brain damage. Diagnosis is clinical, often including neuropsychologic testing, with brain imaging (eg, CT, MRI) to identify cause. Prognosis depends on the cause and extent of damage and patient age. There is no specific treatment, but […]

aphasia

Aphasia is language dysfunction that may involve impaired comprehension or expression of words or nonverbal equivalents of words. It results from dysfunction of the language centers in the cerebral cortex and basal ganglia or of the white matter pathways that connect them. Diagnosis is clinical, often including neuropsychologic testing, with brain imaging (CT, MRI) to […]

amnesia

Amnesia is partial or total inability to recall past experiences. It may result from traumatic brain injury, degeneration, metabolic disorders, seizure disorders, or psychologic disturbances. Diagnosis is clinical but often includes neuropsychologic testing and brain imaging (eg, CT, MRI). Treatment is directed at the cause. Processing of memories involves registration (taking in new information), encoding […]

intracranial tumors

Intracranial tumors may involve the brain or other structures (eg, cranial nerves, meninges). The tumors usually develop during early or middle adulthood but may develop at any age; they are becoming more common among the elderly. Brain tumors are found in about 2% of routine autopsies. Some tumors are benign, but because the cranial vault […]

rehabilitation

Rehabilitation aims to facilitate recovery from loss of function. Loss may be due to fracture, amputation, stroke or another neurologic disorder, arthritis, cardiac impairment, or prolonged deconditioning (eg, after some disorders and surgical procedures). Rehabilitation may involve physical, occupational, and speech therapy; psychologic counseling; and social services. For some patients, the goal is complete recovery […]

exercise

Exercise stimulates tissue change and adaptation (eg, increase in muscle mass and strength, cardiovascular endurance), whereas rest and recovery allow such change and adaptation to occur. Recovery from exercise is as important as the exercise stimulus. Regular physical activity reduces the likelihood of medical illness, decreases the incidence of the major causes of death, and […]

foreign travel

About 1 in 30 people traveling abroad requires emergency care. Illness in a foreign country may involve significant difficulties. Many insurance plans, including Medicare, are not valid in foreign countries; overseas hospitals often require a substantial cash deposit for nonresidents, regardless of insurance. Travel insurance plans, including some that arrange for emergency evacuation, are available […]

air travel

Air travel can cause or worsen certain medical problems; some are considered a contraindication to flight (see Table 1: Medical Aspects of Travel: Contraindications to Flying), and others may cause discomfort. Serious complications are rare. During a flight, any health care practitioner among the passengers may be asked to help fellow passengers who become ill. […]

exercise in elderly

At least 75% of people age > 65 yr do not exercise at recommended levels despite the known health benefits of exercise Longer survival Improved quality of life (eg, endurance, strength, mood, flexibility, cognitive function) Furthermore, many elderly people are not aware of how hard to exercise and also do not appreciate how much exercise […]

suicide

Suicidal behavior includes 3 types of self-destructive acts: completed suicide, attempted suicide, and suicide gestures. Thoughts and plans about suicide are referred to as suicide ideation. Completed suicide is a suicidal act that results in death. Attempted suicide is an act intended to be self-lethal, but one that does not result in death. Frequently, suicide […]

gad

Generalized anxiety disorder (GAD) is characterized by excessive, almost daily anxiety and worry for ≥ 6 mo about many activities or events. The cause is unknown, although it commonly coexists in people who have alcohol abuse, major depression, or panic disorder. Diagnosis is based on history and physical examination. Treatment is psychotherapy, drug therapy, or […]

anxiety

Everyone periodically experiences fear and anxiety. Fear is an emotional, physical, and behavioral response to an immediately recognizable external threat (eg, an intruder, a car spinning on ice). Anxiety is a distressing, unpleasant emotional state of nervousness and uneasiness; its causes are less clear. Anxiety is less tied to the exact timing of a threat; […]

hyponatremia

_ _ _ Hyponatremia is decrease in serum Na concentration < 136 mEq/L caused by an excess of water relative to solute. Common causes include diuretic use, diarrhea, heart failure, and renal disease. Clinical manifestations are primarily neurologic (due to an osmotic shift of water into brain cells causing edema), especially in acute hyponatremia, and […]

drugs of consern in elderly

Some drug categories (eg, analgesics, anticoagulants, antihypertensives, antiparkinsonian drugs, diuretics, hypoglycemic drugs, psychoactive drugs) pose special risks for elderly patients. Some, although reasonable for use in younger adults, are so risky as to be considered inappropriate for the elderly. The Beers Criteria are most commonly used to identify such inappropriate drugs (see Table 5: Drug […]

drug related problems in elderly

Drug-related problems include Adverse effects Ineffectiveness Adverse drug effects are effects that are unwanted, uncomfortable, or dangerous. Common examples are oversedation, confusion, hallucinations, falls, and bleeding. Among ambulatory people ≥ 65, adverse drug effects occur at a rate of about 50 events per 1000 person-years. Hospitalization rates due to adverse drug effects are 4 times […]

sleep and wake fullness disorder

The most commonly reported sleep-related symptoms are insomnia and excessive daytime sleepiness (EDS). Insomnia is difficulty falling or staying asleep or a sensation of unrefreshing sleep. EDS is the tendency to fall asleep during normal waking hours. Insomnia and EDS are not disorders themselves but are symptoms of various sleep-related disorders. Parasomnias are abnormal sleep-related […]

parkinsons disease

Parkinson’s disease is an idiopathic, slowly progressive, degenerative CNS disorder characterized by resting tremor, muscular rigidity, slow and decreased movement, and postural instability. Diagnosis is clinical. Treatment is with levodopa plus carbidopa, other drugs, and, for refractory symptoms, surgery. Parkinson’s disease affects about 0.4% of people > 40 yr, 1% of people ≥ 65 yr, […]

neurological procedures

Diagnostic procedures should not be used for preliminary screening, except perhaps in emergencies when a complete neurologic evaluation is impossible. Evidence uncovered during the history and physical examination should guide testing. Lumbar puncture (spinal tap): Lumbar puncture is used to evaluate intracranial pressure and CSF composition (see Table 1: Approach to the Neurologic Patient: Cerebrospinal […]

approach to neurological patient

Patients with neurologic symptoms are approached in a stepwise manner termed the neurologic method, which consists of the following: Identifying the anatomic location of the lesion or lesions causing symptoms Identifying the pathophysiology involved Generating a differential diagnosis Selecting specific, appropriate tests Identifying the anatomy and pathophysiology of the lesion through careful history taking and […]

muscle cramps

A muscle cramp (charley horse) is a sudden, brief, involuntary, painful contraction of a muscle or group of muscles. Cramps commonly occur in healthy people (usually middle-aged and elderly people), sometimes during rest, but particularly during or after exercise or at night (including during sleep—see Sleep and Wakefulness Disorders: Sleep-related leg cramps). Leg cramps at […]

numbness

“Numbness” can be used by patients to describe various symptoms, including loss of sensation, abnormal sensations, and weakness or paralysis. However, numbness is actually loss of sensation, either partial (hypesthesia) or complete (anesthesia). Numbness may involve the 3 major sensory modalities—light touch, pain and temperature sensation, and position and vibration sensation—to the same or different […]

weakness

Weakness is one of the most common reasons patients present to primary care clinicians. Weakness is loss of muscle strength, although many patients also use the term when they feel generally fatigued or have functional limitations (eg, due to pain or limited joint motion) even though muscle strength is normal. Weakness may affect a few […]

memory loss

Memory loss is a common complaint in the primary care setting. It is particularly common among the elderly but also may be reported by younger people. Sometimes family members rather than the patient report the memory loss (typically in an elderly person, often one with dementia). Clinicians and patients are often concerned that the memory […]

coma

Overview of Coma and Impaired Consciousness Share This Coma is unresponsiveness from which the patient cannot be aroused. Impaired consciousness refers to similar, less severe disturbances of consciousness; these disturbances are not considered coma. The mechanism for coma or impaired consciousness involves dysfunction of both cerebral hemispheres or of the reticular activating system (also known […]

subarachnoid heamorrage

Subarachnoid hemorrhage is sudden bleeding into the subarachnoid space. The most common cause of spontaneous bleeding is a ruptured aneurysm. Symptoms include sudden, severe headache, usually with loss or impairment of consciousness. Secondary vasospasm (causing focal brain ischemia), meningismus, and hydrocephalus (causing persistent headache and obtundation) are common. Diagnosis is by CT or MRI; if […]

intracerebral haemorrage

_ _ _ _ _ _ _ _ _ Intracerebral Hemorrhage Share This Intracerebral hemorrhage is focal bleeding from a blood vessel in the brain parenchyma. The cause is usually hypertension. Typical symptoms include focal neurologic deficits, often with abrupt onset of headache, nausea, and impairment of consciousness. Diagnosis is by CT or MRI. Treatment […]

ischemic stroke

Ischemic Stroke Share This Ischemic stroke is sudden neurologic deficits that result from focal cerebral ischemia associated with permanent brain infarction (eg, positive diffusion-weighted MRI). Common causes are (from most to least common) nonthrombotic occlusion of small, deep cortical arteries (lacunar infarction); cardiogenic embolism; arterial thrombosis that decreases cerebral blood flow; and artery-to-artery embolism. Diagnosis […]

stroke

Overview of Stroke (Cerebrovascular Accident) Share This Strokes are a heterogeneous group of disorders involving sudden, focal interruption of cerebral blood flow that causes neurologic deficit. Strokes can be ischemic (80%), typically resulting from thrombosis or embolism, or hemorrhagic (20%), resulting from vascular rupture (eg, subarachnoid or intracerebral hemorrhage). Stroke symptoms lasting < 1 h […]

migraine

Migraine is an episodic primary headache disorder. Symptoms typically last 4 to 72 h and may be severe. Pain is often unilateral, throbbing, worse with exertion, and accompanied by symptoms such as nausea and sensitivity to light, sound, or odors. Auras occur in about 25% of patients, usually just before but sometimes after the headache. […]

headaches

Headache is pain in any part of the head, including the scalp, face (including the orbitotemporal area), and interior of the head. Headache is one of the most common reasons patients seek medical attention. Pathophysiology Headache is due to activation of pain-sensitive structures in or around the brain, skull, face, sinuses, or teeth. Etiology Headache […]

dementia

Dementia is a broad category of brain diseases that cause a long-term and often gradual decrease in the ability to think and remember that is severe enough to affect daily functioning.[2] Other common symptoms include emotional problems, difficulties with language, and a decrease in motivation.[2][3] Consciousness is usually not affected.[11] A diagnosis of dementia requires a change from a person’s usual mental functioning and a greater decline […]

epilepsy

Seizure Disorders Share This (See also Neurologic Disorders in Children: Febrile Seizures and see also Neurologic Disorders in Children: Neonatal Seizure Disorders.) A seizure is an abnormal, unregulated electrical discharge that occurs within the brain’s cortical gray matter and transiently interrupts normal brain function. A seizure typically causes altered awareness, abnormal sensations, focal involuntary movements, […]

In the search of the perfect man….by dr behchch

In the search of the perfect man…. 12 Dec While surfing net, I came across the picture in which five skeletons were sitting on the dining table with wine glasses on the top. ‘Women waiting for a perfect man’ was the caption of the picture. “Just right” I uttered almost instantly about the concept and […]